When Parents Become Part of the Care Team: Does It Help Premature Babies Go Home Sooner?

A plain-language look at the Hoeben 2026 Dutch study of family-involved care in private neonatal rooms

Researchers in the Netherlands compared premature babies cared for in a unit where parents could stay day and night and take on much of their baby's daily care with babies in traditional units where parents could visit but not stay overnight. After allowing for the fact that the babies in the family-involved unit were smaller and sicker to begin with, those babies went home about two days sooner and spent fewer days with drips and feeding tubes. The study was not a randomised experiment, so it cannot prove that the care model caused the shorter stay, but the results are encouraging.

Why the length of a hospital stay matters to families.

When a baby is born early, one of the first questions parents ask is, "When can we take our baby home?" The answer depends on many things: whether the baby is breathing comfortably, gaining weight, keeping warm, and feeding well. It also depends, to some extent, on how a hospital works. This article describes a recent study ^[1] that asked whether involving parents much more closely in their baby's care could help babies leave the hospital sooner, without any harm to the baby.

Doctors know that the time premature babies spend in hospital differs from one country and network of hospitals to another, even for babies born at similar stages of pregnancy ^[2]. This suggests that the way care is organised, not only how sick a baby is, plays a part. Time in hospital also matters because being born early can have wide costs for health services and for families, both at the start and later on ^[3]. Parents may be away from work, travelling back and forth, and worrying every day.

How neonatal care changed from parents as visitors to parents as caregivers.

In the past, hospitals often thought of the newborn unit as a place where nurses and doctors did the caring and parents came to visit. In many units, several babies shared one large room, called an open bay, with little privacy and no place for parents to stay overnight. Parents were often not present when doctors discussed their baby's care on rounds.

Over time, many people began to feel that this arrangement kept parents on the sidelines. One response was to change the buildings, moving babies into single family rooms, private rooms where parents can stay with their baby. Researchers have pooled the studies that compared single family rooms with open bay units ^[4]. But a private room by itself does not change who does the caring. A second idea, called Family Integrated Care, or FICare, is about changing the role of parents: they become their baby's main caregivers, with support and teaching from nurses.

The Dutch research team behind this study had already looked at how these ideas affect parents. They studied how a care model in which parents and baby are never separated related to stress in mothers ^[5], and how a family-integrated model related to fathers' mental health ^[6]. This new study looked at the babies' own health and hospital stay.

Other researchers had tested FICare in carefully designed trials, in which whole hospital units, not individual babies, were randomly assigned to use FICare or usual care. These included a large trial across several hospitals in different countries ^[7], a trial in Alberta, Canada, that looked at length of stay in mid-level newborn units ^[8] and at other outcomes for babies ^[9], and a trial in China ^[10]. The Dutch study looked at what happens in a unit in the Netherlands that had been running FICare in private family rooms since 2014.

What the researchers did.

The study followed 358 premature babies in three mid-level newborn units in the Netherlands between 2016 and 2020 ^[1]. One unit used FICare in single family rooms, and cared for 169 babies. The other two units used standard care in open bay rooms, and cared for 189 babies. The study is called the AMICA study. The babies had to stay in hospital at least a week to be included.

Because the units had very different buildings, the researchers could not randomly assign babies to one type of care or the other; it would have been impractical and parents in the different types of unit would have influenced each other. So instead, they watched what happened in each unit and compared the results, which is called an observational or cohort study.

In the FICare unit, parents could be there around the clock and were encouraged, though not required, to help with feeding, cuddling skin to skin, bathing, and weighing their baby. Nurses still took care of the medical parts such as drips, breathing support, oxygen, and putting in feeding tubes. Parents also joined the doctors' rounds and helped make decisions. In the standard units, parents were welcome to visit, but could not stay overnight, and did not attend the doctors' rounds ^[1].

One important detail: the babies in the FICare unit were, on average, born earlier (about a week earlier in pregnancy), weighed less, and were more likely to have come from another hospital. More of them also had a lung condition called bronchopulmonary dysplasia (13% compared with 4%). The researchers used statistical methods to allow for these differences ^[1].

What the study found.

Before allowing for these differences, babies in the FICare unit stayed longer, about 27 days compared with 21 days in the standard units. That is what you would expect if the babies were smaller and sicker to begin with. After the researchers accounted for those differences, babies in the FICare unit had a stay about 9% shorter, which works out at around two days ^[1].

The babies in the FICare unit also had fewer days with a drip in a vein, about 45% fewer, and fewer days with a feeding tube, about 21% fewer ^[1]. The researchers' analysis suggested that these two things together explained the shorter stay. A simple way to picture it: when parents are there for every feed and practise feeding with nurses, the baby may learn to feed from the breast or bottle a little sooner. Once a baby feeds well, the drip and the tube can come out, and going home comes closer.

Just as important is what did not differ. Babies in the two groups gained weight at a similar rate. Suspected late-onset infections were not significantly different, with 9% in the FICare unit and 6% in the standard units, and neither were the number of babies who had to return to hospital in the first three months after their due date, at 15% and 12%. The share of babies receiving only their mother's milk when they went home was also not significantly different after adjustment (63% and 70%) ^[1]. In this study, going home a little sooner did not come at the cost of slower growth or more problems.

There was one finding that needs careful explanation. More babies in the FICare unit went home still needing a feeding tube: 20% compared with 3% in the standard units ^[1]. The researchers' analysis did not find that this explained the shorter stay, but it is worth knowing about. Some parents in the FICare unit were trained to give tube feeds at home, and families in that position need good teaching and follow-up support.

What this means for your baby and your family.

If your baby is in a newborn unit, this study does not mean that one type of unit is better than another, and it does not mean that parents who cannot be there every hour are doing anything wrong. Every family has different circumstances, including work, other children, and health. The study shows that when parents are supported to take an active role, the baby's stay may be shorter, but the FICare unit in this study also gave parents education, physical support, and psychological support ^[1].

Some ways to be involved that fit many families include asking to take part in feeds and skin-to-skin cuddling when your baby is stable, asking what the plan is for moving from tube to breast or bottle, and asking to join the discussion on rounds. If your baby needs to go home with a feeding tube, ask about training, a written plan, and who to call.

The authors also point out some limits. This was not a randomised study and only one unit used FICare, so it is hard to be sure that the care model itself, and not something else about that hospital, made the difference. The parents in the study were mostly university educated and of Dutch cultural background, so the results may not apply equally to all families ^[1]. The authors also estimate that a newborn intensive care day in the Netherlands costs about 3,200 euros, so a shorter stay may matter for hospitals and, indirectly, for families, given the financial strain preterm birth can bring ^[3].

What researchers are working on next.

The main goal of the larger AMICA study is to check how the children are developing at age two, which will show whether the shorter stays have any lasting effect; those results are not part of this report. Other researchers want to test family-integrated care in more carefully designed trials, and with families from more varied backgrounds. Until then, the message for families is a hopeful one: when parents are welcomed as partners in caring for a premature baby, babies did not do worse, and they may go home sooner.

References

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2. Seaton SE, Draper ES, Adams M, Kusuda S, Håkansson S, Helenius K, et al. Variations in Neonatal Length of Stay of Babies Born Extremely Preterm: An International Comparison Between iNeo Networks. J Pediatr. 2021;233:26-32.e6. doi:10.1016/j.jpeds.2021.02.015 ↩
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7. O'Brien K, Robson K, Bracht M, Cruz M, Lui K, Alvaro R, et al. Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial. Lancet Child Adolesc Health. 2018;2(4):245-254. doi:10.1016/S2352-4642(18)30039-730039-7) ↩
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